Exercise Induced Bronchoconstriction

Publication Date: May 1, 2016

Key Points

Key Points

  • The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
  • Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
    • The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
  • The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
  • EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
  • Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.

Diagnosis

Diagnosis

...tement (SS)1: In asthmatic patients EIB can...


...S2: A diagnosis of EIB should be confirmed...


...uate EIB in elite athletes by usin...


...4: Perform a standardized bronchoprovocation (...


...S5: In subjects with no current cl...


...Use an indirect graded challenge (eg,...


...erform an indirect challenge (eg, exercise...


...e ventilation reached and sustained dur...


...S9: Perform EVH as the preferred sur...


...an indirect graded challenge (eg, mannitol) resul...


...ferentiate between EIB and exercise-ind...


SS12: To determine whether exercise-induc...


...S13: Perform spirometry, as well as detailed pulmo...


...14: Consider a diagnosis of exercise-ind...


Treatment

...eatment

...appropriate specialists (eg, cardio...

...: Refer patients for psychological evaluation when...

...7: Schedule regular office visits with pa...


...ergic Receptor Agonists...

...inhaled short-acting β2-adrenergic recep...

...9: Prescribe a single dose of SABA,...

...0: Be cautious in daily use of β2-adrene...


...ukotriene Inhibi...

...onsider prescribing daily therapy...


...ll Stabilizers...

...der prescribing inhaled cromolyn sodium and ne...


ICSs

...S23: Consider prescribing ICSs in combin...

...o NOT prescribe daily LABAs with ICS th...


...cholinergic Agents

...der prescribing inhaled ipratropium bromide...


...npharmacologic Therapy

...ibe pre-exercise warm-up for EIB because it...

...with caution the recommendation of reduction of s...


...petitive and Elite Ath...

SS28: Treat athletes with EIB alone in a simi...


...orithm for the Diagnosis, Treatment, and Dif...